How an HIV Outbreak Hit the Heartland

Indiana Governor Mike Pence on Thursday declared a public health emergency in a rural Indiana county after 79 cases of HIV were confirmed there in the last several months.

An outbreak of HIV may seem odd in such a remote part of the country. The dozens of confirmed cases, described as an epidemic, are centered in Scott County, about a half-hour north of Louisville with a population of about 25,000.

But the spike has been fueled by growing heroin and drug use in rural counties like this one. A number of Midwestern states have struggled with a recent uptick in drug and needle use, and Indiana specifically has seen an increase in the use of a powerful painkiller called Opana, which can be altered and injected. The number of deaths related to opioids like Opana rose from 200 a year in 2002 to 700 in 2012, according to the Indiana…